Abstract WP12: Early or Later Anticoagulation in Post-Stroke Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Uncertainty regarding the timing of anticoagulant initiation after an ischemic stroke in patients with atrial fibrillation arises from the lack of extensive data on this matter. We conducted the first meta-analysis, including only randomized controlled trials, to clarify this question.

Methods: We systematically searched Embase, PubMed, and Cochrane Library in June 2023 for studies comparing early versus late initiation of anticoagulation post-stroke in patients with atrial fibrillation. Statistical analyses were performed using R software version 5.4.1.

Results: We included three studies comprising 2,989 patients. Of these, 1,497 (50%) received early anticoagulation with a direct oral anticoagulant (DOAC), and 1,492 (50%) received later anticoagulation with a DOAC or warfarin. 51.66% of participants were women. The use of early anticoagulation was associated with a lower incidence of recurrent ischemic stroke; nonetheless, this result lacked statistical significance (RR 0.68; 95% CI 0.44-1.04; p=0.07; I ² =0%). The number of symptomatic intracerebral hemorrhage events was 2 in the early anticoagulation group and 3 events in the later anticoagulation group, with no statistical significance between the groups.

Conclusion: Our findings suggest no statistically significant difference in recurrent ischemic stroke and intracerebral bleeding between the initiation of early or later anticoagulation in post-stroke patients with atrial fibrillation.